Yale School of Medicine
Center for Outcomes Research & Evaluation (CORE)Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart Failure
MedicalResearch.com: What are the main findings of the study?
We found that among a large contemporary cohort of heart failure hospitalizations, beta blockers are frequently started in patients with markers of clinical instability such as residence in an intensive care unit (ICU), volume overload requiring intravenous diuresis, and poor cardiac output requiring intravenous inotropes. Approximately 40% of patients in whom a beta blocker is started has at least one of these three potential contraindications to treatment.
This finding is concerning, as recent performance measures for heart failure recommend that a beta blocker be started during hospitalization for heart failure among patients with left ventricular systolic dysfunction. However, these performance measures also state that persons in whom a beta blocker is started “should not be hospitalized in an ICU, should have no or minimal evidence of fluid overload or volume depletion, and should not have required recent treatment with an intravenous positive inotropic agent.”
Moving forward, we are concerned that the unselective application of the new performance measure may lead to the further use of beta blocker therapy in patients at higher risk for adverse consequences of therapy.
MedicalResearch.com: What should clinicians and patients take away from your report?
Care should be taken when initiating a beta blocker during hospitalization for heart failure to make sure patients have no evidence of clinical instability.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
We need randomized studies that demonstrate the efficacy of beta blocker initiation during hospitalization for heart failure. These studies will also need to determine the subgroups of patients most likely to benefit and most likely to experience adverse health outcomes from inpatient beta blocker initiation.
Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart Failure